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慢性丙型肝炎治疗新策略概述。

An overview of emerging therapies for the treatment of chronic hepatitis C.

机构信息

Liver Center, St Luke's Episcopal Hospital, Baylor College of Medicine, 1709 Dryden, Suite 1500, Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, 1709 Dryden Street, Suite 500, Houston, TX 77030, USA; Department of Surgery, Baylor College of Medicine, 1709 Dryden Street, Suite 1500, Houston, TX 77030, USA.

出版信息

Med Clin North Am. 2014 Jan;98(1):17-38. doi: 10.1016/j.mcna.2013.10.011.

Abstract

Advances in our understanding of the HCV lifecycle and refinement of in vitro methods to select candidate compounds with anti-HCV activity have led to development of DAA agents and other novel antiviral therapies capable of increasing the curative SVR rates in patients with CHC. The use of the liner protease inhibitors telaprevir and boceprevir, in combination with Peg-IFN-a and ribavirin has become the new SOC for treatment of CHC genotype 1. Rapid development of new protease inhibitors, NI and NNI NS5B polymerase inhibitors, NS5A inhibitors, Peg-IFN-l, cyclophilin inhibitors, caspase inhibitors, and therapeutic vaccines promises to provide even safer and more effective therapy. Combination therapies with 2 or more oral agents may permit elimination of Peg-IFN-a in the near future. Introduction of DAA therapies will confront physicians and patients with regimens of increased complexity, a greater need for compliance, and the necessity of monitoring for virological resistance. Patients with CHC should continue to consider participation in clinical trials of new therapies to accelerate progress.

摘要

我们对 HCV 生命周期的认识不断提高,并且改进了体外方法以选择具有抗 HCV 活性的候选化合物,这导致了 DAA 药物和其他新型抗病毒疗法的发展,这些疗法能够提高 CHC 患者的治愈性 SVR 率。线性蛋白酶抑制剂特拉普韦和博赛泼维与 Peg-IFN-a 和利巴韦林联合使用,已成为治疗 CHC 基因型 1 的新标准治疗方案。新型蛋白酶抑制剂、NI 和 NNI NS5B 聚合酶抑制剂、NS5A 抑制剂、Peg-IFN-l、亲环素抑制剂、半胱天冬酶抑制剂和治疗性疫苗的快速发展有望提供更安全、更有效的治疗方法。两种或更多种口服药物的联合治疗可能会在不久的将来消除 Peg-IFN-a 的使用。DAA 疗法的引入将使医生和患者面临更加复杂的治疗方案、更高的依从性需求以及对病毒耐药性监测的必要性。CHC 患者应继续考虑参与新疗法的临床试验,以加速进展。

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